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Intervention-induced visceral fat loss linked to ~28% lower incident T2D risk per ten percent reduction.
Why the study?
Although participants achieved reductions in abdominal and ectopic fat during two lifestyle trials, the long-term postintervention cardiometabolic profile associated with these changes remained to be examined.
Does lifestyle-induced visceral fat loss improve long-term cardiometabolic health and reduce incident type 2 diabetes in participants of dietary trials?
Population
366 participants from the CENTRAL and DIRECT-PLUS trials
Comparison
Dietary patterns combined with structured physical activity
Design
Post-trial follow-up of 2 randomized controlled trials
Follow-up
5 and 10 years after completion of the trials
Key result
Each 10% intervention-induced loss of visceral adipose tissue was associated with a 28% lower risk of incident type 2 diabetes (HR 0.72; 95% CI 0.54-0.94) during 5- and 10-year follow-up.
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Repeated participation in a lifestyle program for weight loss, even after a perceived 'failure,' may lead to significant health benefits over the years, especially in reducing dangerous abdominal fat.”
“Weight alone does not accurately reflect abdominal fat or blood parameters. Therefore, even if the weight comes back, it is very possible that health is still improved, and the success of a process cannot be defined solely by a number on the scale.”
Overview
Visceral fat loss may inform diabetes prevention targets; hypothesis-generating and requires randomized confirmation.
Key Points
- This research investigates the long-term cardiometabolic effects of visceral fat loss from lifestyle interventions.
- Participants from two clinical trials were followed up 5 and 10 years post-intervention.
- Magnetic resonance imaging assessed various fat depots including visceral adipose tissue.
- Participants' metabolic profiles were measured including insulin resistance and diabetes risk.
- 366 out of 381 eligible participants were successfully followed up (96%).
- 10% loss of visceral fat was associated with a 28% lower risk of incident type 2 diabetes (HR 0.72, 95% CI 0.54–0.94, P < 0.05).
- Despite weight regain, reductions in abdominal fat were partially maintained after 5-10 years.
Study Design
Type
RCT (n=366)
Structured PICO
Does lifestyle-induced visceral fat loss improve long-term cardiometabolic health and reduce incident type 2 diabetes in participants of dietary trials?
P
Population
366 participants from two previous 18-month lifestyle intervention trials followed up at 5 and 10 years to assess long-term cardiometabolic profiles.
I
Intervention
Dietary patterns (low-fat, healthy dietary guidelines and Mediterranean diet variants, including standard, low-carbohydrate, and polyphenol-enriched 'green' Mediterranean diets) combined with structured physical activity
O
Outcome
Long-term postintervention cardiometabolic profile (Metabolic Score for Insulin Resistance, composite risk score, Metabolic Syndrome Severity Score) and incident type 2 diabetessurrogate
Main Result
Hazard Ratio: 0.72 (95% CI 0.54–0.94)
Lifestyle-induced visceral fat loss, rather than overall weight loss, is a key target for durable cardiometabolic health and reduces the long-term risk of incident type 2 diabetes.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Trending Research#7 this week
This long-term follow-up of the CENTRAL and DIRECT-PLUS trials provides compelling evidence that visceral fat loss, independent of overall weight regain, has durable cardiometabolic benefits. The findings are highly relevant to preventive cardiology, shifting the focus from just weight loss to the importance of reducing visceral adiposity.
Social attention
78
Preprint velocity
0
News coverage
80
Conference
0
Expert commentary
0
Cite This Study
Klein et al. (2026) conducted an RCT in Cardiometabolic health (n=366). Lifestyle interventions (diet and physical activity) was evaluated on incident type 2 diabetes (HR 0.72, 95% CI 0.54-0.94). Each 10% intervention-induced loss of visceral adipose tissue was associated with a 28% lower risk of incident type 2 diabetes (HR 0.72; 95% CI 0.54-0.94) during 5- and 10-year follow-up.